TCORS 2.0: Center for the Assessment of Tobacco Regulations (CAsToR)

Pilot + Feasibility

2021 Funding Cycle Awardees

View other award years: 202220202019

Please note: Listing describes appointments and affiliations at the time of award. Please check our Trainees page for current appointments and affiliations.

Selected pilot project

Title: “A Longitudinal Investigation of the Contribution of Menthol Cigarettes to Disparities in Smoking Cessation and Transitions to Nicotine Vaping Products by Race, Sex, and Socioeconomic Status Using the ITC US Surveys, 2002-2020”
PI: Dr. Pete Driezen, Research Assistant Professor at University of Waterloo
Abstract and accomplishments +
Dr. Pete Driezen
Dr. Pete DriezenUniversity of Waterloo
Abstract
Introduction: Menthol cigarettes contribute to tobacco-related health disparities in the United States. Using nationally representative survey data from 12 waves of the US arm of the International Tobacco Control (ITC) Survey, this research will examine sex, race, SES, and geographic disparities in the use of menthol cigarettes among US smokers, and how disparities might influence transitions to non-menthol cigarettes, smoking cessation, and uptake of e-cigarettes (EC). Aims: Aim 1: Estimate longitudinal trends in menthol use among US smokers from 2002 to 2020 at national and census division levels and whether disparities in menthol use changed over time between subgroups (e.g., female vs. male smokers, Black smokers vs. those from other racial/ethnic groups, low vs. high SES smokers). Aim 2: Model transitions in menthol use from 2002 to 2020 and whether smoking cessation rates changed over time by menthol use. Additional exploratory models will examine whether trends differed by sex, race, and SES subgroups. Aim 3: Explore transitions from combustible cigarettes to exclusive use of EC from 2016 to 2020. Methods: For Aim 1, statistical small area estimation methods will generate disaggregated estimates of menthol use at the census division level in key subgroups. These methods borrow strength from auxiliary data to efficiently estimate prevalence using survey data with small subgroup samples. For Aims 2 and 3, weighted multivariable logistic regression models, fit using generalized estimating equations (GEE), will be used to estimate the log odds of transitioning (e.g., from menthol to non-menthol) at wave t+1 based on menthol use at wave t. Implications: Sub-national estimates oflongitudinal trends in menthol use in key subgroups can inform modeling studies of the effects of menthol use in those subgroups. Longitudinal trends in the transitions from/to menthol cigarettes provide insight into the long-term stability of menthol use among US smokers; whether trends differ by sex, race, or SES; and whether disparities have worsened. This research will provide population-level evidence suggesting how menthol use might lead to continued disparities in US smoking prevalence.
Accomplishments
Coming Soon!
Title: “Automating the detection of American adolescents at risk of e-cigarette dependence using machine learning”
PI: Dr. Rui Fu (Ray), Postdoctoral Fellow at University of Toronto
Abstract and accomplishments +
Dr. Rui Fu (Ray)
Dr. Rui Fu (Ray)University of Toronto
Abstract
Introduction: American adolescents are showing a concerning trend in frequent e-cigarette use (vaping) that might indicate signs of dependence. Although risk factors for vaping dependence have been assessed using conventional regression, these approaches have limitations when dealing with a large number of potential predictors and complex non-linear interactions. Furthermore, a practical model capable of accurately identifying adolescents at risk of vaping dependence has yet to be developed to allow for a timely intervention. Aims: The overarching aim of this project is to develop and validate machine learning models to predict the status of frequent vaping—defined as nicotine-containing vaping in 20 or more days in past 30 days—in 6, 12 and 24 months after baseline. Using these models, we further identify the top predictors of frequent vaping and important interactions formed by sociodemographic variables to characterize vulnerable subgroups. Methods: We will use person-level longitudinal survey data from the Los Angeles-based Happiness and Health Study. A wide range of 100+ candidate predictors will be entered into a cross-validation process to construct and validate random forest models. In separate post-hoc analyses, we will identify the top individual predictors and depict sociodemographically based pairwise interactions using partial dependence-based methods. Anticipated Results: We expect the final models to achieve high predictive performance (with a C-statistic of 0.80 or above). We hypothesize certain vaping product characteristics (e-juice flavor, nicotine concentration/formulation, device type) constitute as important predictors of frequent vaping. We also hypothesize that vulnerable subgroups are characterized by perceived discrimination and its interactions with age, sex and race/ethnicity. Implications: This project will provide machine learning models that could potentially enable a public health tool to identify adolescents at risk of progressing to frequent vaping. The findings on risk factors will highlight e-cigarette product characteristics as regulation targets. Identification of vulnerable subgroups will allow for the design of protective measures such as the ban of promotion tactics that appeal to those adolescents.
Accomplishments
Coming Soon!
Title: “Trajectories of Tobacco Use, Stress, and Health among U.S. Transgender Youth and Adults”
PI: Dr. Luisa Kcomt, Assistant Professor at Wayne State University
Abstract and accomplishments +
Dr. Luisa Kcomt
Dr. Luisa KcomtWayne State University
Abstract
Introduction: Despite the growing body of research on transgender health in recent years, there remains limited understanding about gender-fluid individuals (i.e., people who experience changes in gender identity over time) because of conventional conceptualizations of gender and the inability of cross-sectional studies to assess gender fluidity. No studies to date have examined how multi-level factors may influence nicotine/tobacco use among gender-fluid individuals. Aims: Aim 1: Using data from the Population Assessment of Tobacco and Health (Waves 1 through 4), explore potential differences between gender-fluid vs. gender-stable individuals in their age of initiation, frequency, and intensity of nicotine/tobacco use (including combustible cigarettes, e-cigarettes, other tobacco use, and poly-tobacco use), and nicotine/tobacco dependency symptoms across the four waves, and examine trajectories of nicotine/tobacco product use as a function of gender stability/fluidity over time. Aim 2: Guided by the Social Ecological Model, assess individual-, interpersonal-, community-, and policy-level factors hypothesized to influence trajectories of nicotine/tobacco product use among gender-fluid and gender-stable participants over time. Anticipated Results: We expect to quantify the differential risks between gender-fluid versus gender-stable participants and dimensions of tobacco use. We will identify the risk and protective factors of nicotine/tobacco use among gender-fluid and gender-stable individuals over time. Implications: Knowledge about the multi-level factors influencing nicotine/tobacco product use and trajectories among gender-fluid people can inform prevention, intervention, and tobacco control policy efforts for this underrepresented population.
Accomplishments
Coming Soon!
Title: “A Content Analysis of Electronic Cigarette Advertisements on Twitter: Topics and Flavors”
PI: Dr. Ruoyan Sun, Assistant Professor at University of Alabama at Birmingham
Abstract and accomplishments +
Dr. Ruoyan Sun
Dr. Ruoyan SunUniversity of Alabama at Birmingham
Abstract
Introduction: As a result of the rapidly increasing prevalence of vaping among adolescents and young adults, the FDA announced the e-cigarette flavor enforcement policy in early 2020, prohibiting the sale and distribution of unauthorized cartridge-based flavored e-cigarette products (except for tobacco and menthol flavors) in the US. However, little is known about the effectiveness of this enforcement policy. Online e-cigarette advertisements from social media offers a unique opportunity to understand in a timely manner how the e-cigarette shops are responding to the FDA flavor enforcement policy. Aims: By analyzing e-cigarette advertisements on Twitter, this project will evaluate the impact of the FDA flavor enforcement policy and assess online promotional methods adopted by e-cigarette companies in response to this policy. Aim 1: Conduct a content analysis to 1) summarize keywords in e-cigarette advertisements before and after the enforcement policy; and thereby 2) examine whether e-cigarette shops still use flavors to promote e-cigarettes following the FDA flavor enforcement policy. Aim 2: Examine whether there is an increase in advertising of alternative tobacco products as a result of the flavor enforcement policy. Anticipated Results: We expect to find a lower prevalence of online advertisements promoting flavors after the enforcement policy. However, there might be a shift in language or keywords, where flavors were brought up indirectly instead of mentioned explicitly. Alternative tobacco products, such as heated tobacco products (HTPs), are exempt from the FDA flavor enforcement policy. We might see an increase in HTP-related advertisements online. Implications: A successful completion of this project will provide valuable and timely feedback to the effectiveness of the FDA flavor enforcement policy. Our long-term goal is to draw evidence from social media to provide timely feedback on public opinions, to increase public engagement, and to enhance real-time policy-making in tobacco control. To reach this goal in the future, analyses and results from this project will provide a foundation for future larger-scale implementation to evaluate tobacco policies.
Accomplishments
Coming Soon!
Title: “Disparities in flavoring patterns of exclusive, dual, and polytobacco use among youth and adults in the U.S.”
PI: Luis Zavala, Doctoral Student at University of Michigan
Abstract and accomplishments +
Luis Zavala
Luis ZavalaUniversity of Michigan
Abstract
Introduction: The U.S. has made progress in tobacco control, the prevalence of smoking and tobacco use continues decreasing, but many challenges remain. Tobacco use continues to be a leading cause of premature death in the U.S. population. Moreover, the tobacco industry has continued evolving and currently offers a wide variety of options of flavored tobacco products. Previous studies have identified that flavored tobacco products may attract new users, particularly youth and young adults. For this reason, since 2009 the sale, distribution, and marketing of cigarettes with flavors are banned, with the exception of menthol cigarettes. However, there is no similar ban for flavors for the other tobacco products at the national level. Therefore, the current study will estimate the patterns of flavored tobacco use in the context of multiple products (single dual and poly tobacco use), and at the intersection of multiple identities (age, sex, income, and race/ethnicity). Aims: Aim 1: To estimate the prevalence and proportion of flavored tobacco product use for cigarettes, e-cigarettes, smokeless, and cigars for exclusive users, and combinations of flavored products for dual and poly-tobacco users. Aim 2: To determine disparities in dual and poly-tobacco use of flavored products by age, sex, socioeconomic status, and race/ethnicity and at the intersection of multiple identities. Aim 3: To assess the determinants of flavors in tobacco products, and the role of flavors in determining dual and poly-tobacco use.
Accomplishments
Coming Soon!

View other award years: 202220202019